Florida Senate - 2011              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 1838
                                Barcode 548162                          
       Proposed Committee Substitute by the Committee on Health
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         creating the Florida Assisted Living Quality
    4         Improvement Initiative Pilot Project; providing a
    5         purpose; providing definitions; creating the pilot
    6         project in area offices of the Agency for Health Care
    7         Administration; providing an expiration date for the
    8         pilot project; providing requirements for facilities
    9         to be eligible to participate in the pilot project;
   10         authorizing the Department of Elderly Affairs to adopt
   11         rules; providing duties of the department with regard
   12         to the pilot project; requiring the administrator of a
   13         facility that is eligible to participate in the pilot
   14         project to notify the Agency for Health Care
   15         Administration when the facility agrees to enroll;
   16         providing that enrollment in the pilot project is
   17         voluntary; requiring each facility to execute an
   18         agreement that includes a provision authorizing the
   19         agency to terminate the facility’s participation in
   20         the pilot project; providing for open enrollment each
   21         year; providing that a facility’s enrollment in the
   22         pilot project does not prohibit the facility from
   23         seeking alternative accreditation; requiring the owner
   24         or administrator of a facility that is enrolled in the
   25         pilot project to enter into a contract with a quality
   26         improvement team; providing for the composition and
   27         duties of a quality improvement team; providing for
   28         termination of the contract with a quality improvement
   29         team; providing for the resumption of inspections by
   30         the agency if a facility terminates enrollment in the
   31         pilot project; authorizing a facility to terminate its
   32         contract with a quality improvement team and execute a
   33         contract with a another team; requiring the agency to
   34         refer certain complaints regarding a facility to the
   35         quality improvement team; authorizing the agency to
   36         investigate repeated complaints and refer them to the
   37         appropriate law enforcement agency; authorizing the
   38         agency to investigate and conduct periodic appraisal
   39         visits of a facility; authorizing the agency to
   40         terminate a facility from the pilot project and
   41         require that the facility be subject to survey,
   42         inspection, and monitoring visits by the agency;
   43         requiring each quality improvement team to make
   44         available to the agency certain reports; authorizing a
   45         quality improvement team to use electronic means of
   46         capturing data and generating reports; providing that
   47         reports and documents of the quality improvement team
   48         may not be used in certain tort actions; prohibiting
   49         conflicts of interests between a facility owner,
   50         administrator, or employee and the members of a
   51         quality improvement team; providing an effective date.
   53  Be It Enacted by the Legislature of the State of Florida:
   55         Section 1. Florida Assisted Living Quality Improvement
   56  Initiative Pilot Project.—
   57         (1) The purpose of the pilot project is to identify best
   58  practices for providing care to residents of licensed assisted
   59  living facilities, provide caregivers with the competencies and
   60  skills necessary to implement best practices, and develop, in
   61  collaboration with the facility, a quality improvement plan to
   62  reduce the need for institutional care.
   63         (2) As used in this section, the term:
   64         (a) “Agency” means the Agency for Health Care
   65  Administration.
   66         (b) “Department” means the Department of Elderly Affairs.
   67         (3)(a) The pilot project shall be limited to no more than
   68  four approved quality improvement teams throughout the pilot
   69  areas and 20 facilities in each of the area office locations of
   70  the agency which are identified as areas 4, 5, 6, 8, and 11.
   71  This pilot project shall expire in 2016 unless reenacted by the
   72  Legislature.
   73         (b) Eligibility for participation is limited to facilities
   74  that have a good survey track record, have not been cited for
   75  any class I or class II violations, and have no more than five
   76  uncorrected class III violations on the prior two annual surveys
   77  and on any survey that resulted from a complaint.
   78         (4) The department may adopt rules as needed to administer
   79  the pilot project, with input from providers, advocates, the
   80  agency, or others. The department shall:
   81         (a) Establish a method to measure facility improvement and
   82  collect data.
   83         (b) Create criteria for quality improvement plans.
   84         (c) Establish standards and requirements for quality
   85  improvement teams.
   86         (d) Establish the procedures for the agency to use in
   87  approving or revoking approval of quality improvement teams.
   88         (e) Create an enrollment process and implementation
   89  timeline for the pilot project.
   90         (f) Establish a process to notify residents and the local
   91  long-term care ombudsman council of each assisted living
   92  facility that is enrolled in the pilot project.
   93         (g) Establish the components and provisions that must be
   94  contained in a contract between the facility and the approved
   95  quality improvement team.
   96         (h) Establish the procedures for resolving complaints that
   97  are filed against a facility that is enrolled in the pilot
   98  project.
   99         (5) The administrator of a licensed facility that is
  100  eligible to participate in the pilot project shall notify the
  101  agency when the facility agrees to enroll. Enrollment in the
  102  pilot project is voluntary. The agency shall enroll the first 20
  103  eligible facilities in each area that seek enrollment. Before
  104  enrollment, each facility must execute a memorandum of agreement
  105  with the agency which includes a provision authorizing the
  106  agency to terminate the facility’s participation in the pilot
  107  project at will. The agency’s termination of a facility from the
  108  pilot project may not be challenged or appealed under chapter
  109  120, Florida Statutes.
  110         (6) Open enrollment in the pilot project shall begin on
  111  January 1 of each year. A facility’s enrollment in the pilot
  112  project does not prohibit the facility from seeking alternative
  113  accreditation from a recognized health care accreditation
  114  organization, such as the Commission on Accreditation of
  115  Rehabilitative Facilities or The Joint Commission.
  116         (7) The owner or administrator of each facility enrolled in
  117  the pilot project shall enter into a contract with an approved
  118  quality improvement team to develop, in accordance with the
  119  department’s rules, and implement a quality improvement plan for
  120  that facility. The facility must pay the quality improvement
  121  team reasonable compensation for the services provided under the
  122  contract. The quality improvement plan must be approved by the
  123  agency prior to any implementation of the plan. The owner or
  124  administrator shall consult with the quality improvement team
  125  for the purpose of meeting the goals outlined in the quality
  126  improvement plan.
  127         (8) Each quality improvement team must evaluate the
  128  progress of the facility in meeting the goals of the quality
  129  improvement plan. A quality improvement team shall include a
  130  quality improvement specialist who has professional expertise or
  131  a background in working with behavioral health needs or aging
  132  related needs, a licensed registered nurse, a licensed
  133  dietician, and a staff development representative.
  134         (9) Each quality improvement team must be approved by the
  135  agency prior to entering into any contract with a facility. The
  136  agency may revoke the approval of the quality improvement team
  137  if the quality improvement team does not meet the requirements
  138  or standards established by department rule. If such approval is
  139  revoked, the quality improvement team may no longer provide
  140  contract services to the facility and the facility must, within
  141  30 days, enter into a contract with another approved quality
  142  improvement team in order to remain enrolled in the pilot
  143  project.
  144         (10) Each quality improvement team shall:
  145         (a) Conduct an annual assessment and followup visits as
  146  needed to monitor the progress of the facility in meeting the
  147  goals of the quality improvement plan.
  148         (b) Consult with the owner and administrator of the
  149  facility in meeting plan requirements, create systems to monitor
  150  compliance with agency rules, ensure that training standards
  151  established under s. 429.52, Florida Statutes, are met, and
  152  provide access to community-based services that would improve
  153  the care of the residents and the conditions in the facility.
  154         (c) Maintain records of the assessments and ongoing efforts
  155  to help the facility meet quality improvement goals.
  156         (d) Issue a certification to each facility that meets
  157  agency standards and is in compliance with the goals of its
  158  quality improvement plan.
  159         (11) A quality improvement team may terminate, without
  160  penalty, the contract executed under subsection (7) with a
  161  facility that has failed to meet the goals of the plan after
  162  reasonable efforts are made to seek cooperation and assistance
  163  from the owner and the administrator of the facility. If a
  164  contract is terminated under these conditions, the facility is
  165  automatically terminated from the pilot project.
  166         (12) If a facility’s enrollment in the pilot project is
  167  terminated, the quality improvement team shall notify the agency
  168  and that facility shall be subject to the survey, inspection,
  169  and monitoring visits conducted under s. 408.811, Florida
  170  Statutes. The facility is not eligible to reenroll in the pilot
  171  project until the agency has certified that the facility is in
  172  substantial compliance with agency rules.
  173         (13) A facility that has entered into a contract with an
  174  approved quality improvement team may terminate that contract
  175  without penalty and enter into a contract with another approved
  176  team. If such termination is sought, the facility administrator
  177  shall notify the agency area office in writing and specify the
  178  reasons the facility seeks to terminate the contract. The area
  179  office supervisor shall approve or reject the request under the
  180  terms and conditions of the memorandum of agreement completed by
  181  the facility before enrolling in the pilot project.
  182         (14) The agency shall refer any complaint concerning the
  183  facility to the quality improvement team if the complaint does
  184  not allege immediate jeopardy to a resident of the facility,
  185  serious substandard care, or actual harm to a resident of the
  186  facility. The team shall investigate the complaint and work with
  187  the owner or administrator to address the complaint. If there is
  188  a pattern of repeated complaints, the agency may investigate
  189  those complaints and refer the complaints to the appropriate law
  190  enforcement agency in the local jurisdiction for investigation
  191  to ensure the health, safety, and well-being of the facility’s
  192  residents.
  193         (15) The agency may investigate and conduct periodic
  194  appraisal visits at any time in order to ensure compliance with
  195  Florida law and the approved quality improvement plan and assess
  196  the quality improvement team and the facility. If the agency
  197  finds that the facility is in substantial noncompliance with the
  198  quality improvement plan or state law, the agency may terminate
  199  the facility from the pilot project and shall require the
  200  facility to be subject to the survey, inspection, and monitoring
  201  visits conducted under s. 408.811, Florida Statutes.
  202         (16)(a) Each quality improvement team shall make available
  203  to the agency reports generated following a visit to an enrolled
  204  facility.
  205         (b) Each quality improvement team may use electronic means
  206  of capturing data and generating reports relating to compliance
  207  with the quality improvement plan.
  208         (17) Reports and documents generated by the quality
  209  improvement teams may not be used in any tort action sought
  210  against the licenseholder of an enrolled facility.
  211         (18) A facility owner, administrator, or employee may not
  212  have an ownership interest in, or provide services to, any
  213  business owned by a member of a quality improvement team, and an
  214  owner, administrator, or employee may not participate as a
  215  member of a quality improvement team. The agency shall ensure
  216  that there are no conflicts of interest between the members of a
  217  quality improvement team and a facility that seeks to enroll or
  218  that is enrolled in the pilot project.
  219         Section 2. This act shall take effect July 1, 2011.